Disparities in Potentially Avoidable Emergency Department (ED) Care ED Visits for Ambulatory Care Sensitive Conditions
Disparities in Potentially Avoidable Emergency Department (ED) Care ED Visits for Ambulatory Care Sensitive Conditions
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DOI：
10.1097/mlr.0b013e318270bad4
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发表时间：
2012-12-01
期刊：
影响因子：
3
通讯作者：
Hokanson, Jon S.
中科院分区：
文献类型：
--
作者：
Johnson, Pamela Jo;Ghildayal, Neha;Hokanson, Jon S.
简介：门诊护理敏感条件（ACSC）的医院护理可能是可以避免的，并且通常被视为初级护理不佳的指标。然而，在急诊科（艾德）环境中也会发生与卫生保健系统的潜在可预防接触。我们研究了艾德访问，以确定亚群不成比例地使用ED ACSC care.Methods：我们分析了2007-2009年全国医院门诊医疗服务调查的78,114艾德访问的18岁及以上的成年人的数据。结局是根据主要艾德诊断确定的ACSC访视。我们构建了与医疗保健研究和质量机构的优先人群相一致的分析小组。采用多变量logistic回归分析来估计全因、急性和慢性ACSC访视的几率。我们使用Stata SE调查技术来解释复杂的调查design.Results：总体而言，8.4%的艾德访问是ACSC，代表超过800万潜在的可避免的艾德访问每年。ACSC访视比非ACSC访视更可能导致住院（34.4% vs. 14.0%，P < 0.001）。多变量模型显示ACSC访问的种族/民族，保险状况，年龄组和社会经济地位的艾德显着差异，虽然模式不同的急性和慢性ACSC.Conclusions：不成比例的高使用ED ACSC护理存在许多优先人群和更广泛的优先人群比以前记录。这些差异构成了ACSC潜在可避免的艾德访视的差异。为了避免加剧差距，卫生政策的努力，以尽量减少经济效率低下的医疗服务，通过限制艾德访问ACSC应首先解决其决定因素。
Introduction: Hospital care for ambulatory care sensitive conditions (ACSC) is potentially avoidable and often viewed as an indicator of suboptimal primary care. However, potentially preventable encounters with the health care system also occur in emergency department (ED) settings. We examined ED visits to identify subpopulations with disproportionate use of EDs for ACSC care.Methods: We analyzed data from the 2007-2009 National Hospital Ambulatory Medical Care Survey for 78,114 ED visits by adults aged 18 and older. Outcomes were ACSC visits determined from the primary ED diagnosis. We constructed analytic groups aligned with Agency for Healthcare Research and Quality's priority populations. Multivariate logistic regression was used to estimate the odds of all-cause, acute, and chronic ACSC visits. We used Stata SE survey techniques to account for the complex survey design.Results: Overall, 8.4% of ED visits were for ACSC, representing over 8 million potentially avoidable ED visits annually. ACSC visits were more likely to result in hospitalization than non-ACSC visits (34.4% vs. 14.0%, P < 0.001). Multivariate models revealed significant disparities in ACSC visits to the ED by race/ethnicity, insurance status, age group, and socioeconomic status, although patterns differed for acute and chronic ACSC.Conclusions: Disproportionately higher use of EDs for ACSC care exists for many priority populations and across a broader range of priority populations than previously documented. These differences constitute disparities in potentially avoidable ED visits for ACSC. To avoid exacerbating disparities, health policy efforts to minimize economic inefficiencies in health care delivery by limiting ED visits for ACSC should first address their determinants.